Behavior Disorders Final Exam

What is the prognosis for Personality disorders?

Generally poor

What is the reason for the prognosis of personality disorders being the way it is?

1. It’s a chronic condition

2. Patients don’t feel that treatment is necessary

What criteria must be meant for a patient to be diagnosed with a personality disorder?

Patient must have enduring and inflexible predispositions

• Must be maladaptive, causing distress and/or impairment

What is the dimensional model for personality disorders?

Individuals are rated on the degree to which they exhibit various personality traits

What is the Five-Factor model?

“Big Five” dimensions of personality disorders; this is NOT used in the DSM-5

• Openness to experience

• Conscientiousness

• Extraversion

• Agreeableness

• Neuroticism

How does the big five for personality disorders vary across cultures?

Cross-cultural research establishes the relatively universal nature of the five dimensions

What do some people want to replace the term “personality disorder” with?

Interpersonal disorders since personality disorders cause so many interpersonal problems

• most likely will not happen

Since the five-factor model is not use by the DSM-5 for personality disorders, what is used?

The level of personality functioning scale

Describe the level of personality functioning scale.

Two domains: self and Interpersonal With two subdomains each. For self they are identity and self-direction and for interpersonal they are empathy and intimacy

Name and describe the subdomains of the self domain in the level of personality functioning scale.

Identity: A person’s knowledge and awareness of self

Self-direction: Internal ability to establish and achieve reasonable expectations of themselves, personal goals, and standards of personal conduct

Name and describe the interpersonal subdomains of the level of personality and functioning scale.

• empathy: Ability to understand and consider another person’s experience, including their thoughts, feelings, beliefs, and motivations

• Intimacy: Desire and ability to form and maintain close, caring, meaningful, and reciprocal relationships

What are the key features of the DSM-5 level of personality functioning scale?

1. impairment (rated for each domain from “little or no impairment” to “extreme impairment”)

2. lack of flexibility across situations and time

What is the prevalence of personality disorders?

Affects about 10% of the general population

Describe the origins and course of personality disorders.

• Thought to begin in childhood

• Tend to run a chronic course if untreated

• May transition into a different personality disorder

Describe the gender distribution and gender bias in diagnosis Of personality disorders.

Men more often show traits like aggression and detachment; women more often show deference to others and insecurity in interpersonal relationships

Who is more often diagnosed with antisocial personality disorder?

Males

Who is more often diagnosed with dependent personality disorder?

Females

Are personality disorders comobird? If so, with what?

Often have two or more personality disorders or an additional mood or anxiety disorder

What are the personality disorder clusters?

Cluster A = odd or eccentric

Cluster B = dramatic or erratic

Cluster C = anxious or fearful

Describe Cluster A of the personality disorder cluster.

Cluster A = Odd or Eccentric

• Paranoid, Schizoid, and Schizotypal personality disorder

Describe Cluster B of the personality disorder cluster.

Cluster B = Dramatic or Erratic

• Antisocial, Borderline, Histrionic, and Narcissistic personality disorder

Describe Cluster C of the personality disorder cluster.

Cluster C = Anxious or Fearful

• Avoidant, Dependent, and Obsessive-compulsive personality disorder

What is being described below?

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.

Paranoid personality disorder

What is being described bellow? A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings.

Schizoid personality disorder

What is being described below? A pervasive pattern of social and interpersonal deficits marked by acute discomfort with reduced capacity for close relationships, as well as by cognitive or perceptual distortions and eccentricities of behavior.

Schizotypal personality disorder

What are the theorized causes of schizotypal personality disorder?

• Mild expression of “schizophrenia genes”?

• May be more likely to develop after childhood maltreatment or trauma, especially in men

• More generalized brain deficits may be present

Describe the treatment plan for schizotypal personality disorder.

• Address comorbid depression

• Main focus is combination of medication, cognitive behavior therapy, and social skills training

What are the characteristics of schizotypal personality disorder? (5)

• Behavior and beliefs are odd and unusual

• Socially isolated and highly suspicious

• Magical thinking, ideas of reference, and illusions (not delusions)

• Many meet criteria for major depression

• Some conceptualize this as resembling a milder form of schizophrenia

Describe the etiology of schizoid personality disorder.

unclear but may have significant overlap with autism spectrum

disorder

Provide an overview of schizoid personality disorder. (2)

• Pervasive pattern of detachment from social relationships

• Very limited range of emotions in interpersonal situations

Describe the treatment for schizoid personality disorder.

focus on the value of interpersonal relationships and on building empathy and social skills

What three personality disorders belong to Cluster A?

1. Paranoid personality disorder

2. Schizoid personality disorder

3. Schizotypal personality disorder

Provide an overview of paranoid personality disorder.

• Pervasive and unjustified mistrust and suspicion

• Few meaningful relationships, sensitive to criticism

What are some theorized causes of paranoid personality disorder?

may involve early learning that people and the world are dangerous or deceptive

What are some cultural factors of paranoid personality disorder?

more often found in people with experiences that lead to mistrust of others (e.g., prisoners, refugees)

Describe treatment of paranoid personality disorder.

focuses on development of trust; cognitive therapy to counter negativistic thinking

Provide an overview of antisocial personality disorders being characteristics.

• Failure to comply with social norms

• Violation of the rights of others

• Irresponsible, impulsive, and deceitful

• Lack of a conscience, empathy, and remorse

• May be very charming, interpersonally manipulative

What are some of the overlapping features between sociopathy and psychopathy?

• lack of empathy or remorse

• Takes no responsibility for their actions

• Doesn’t follow rules

• Doesn’t respect boundaries

What are some features of psychopathy?

• lack of fear

• Difficulty wit emotional regulation

• Uses insincere charm to mask true feelings

• Limited understanding of right and wrong

What are some of the features of sociopathy?

• frequently gets in trouble with the law

• Makes impulsive decisions with no regard for safety

• Increased aggression and risk for violence

• Inability to follow through on personal responsibilities

What are some of the theorized causes of antisocial personality disorder?

• “Callous-unemotional” type of conduct disorder more likely to evolve into antisocial PD

• Families with inconsistent parental discipline and support

• Families often have histories of criminal and violent behavior

• Recent research suggests that psychopathy is a less reliable predictor of criminality (and there are “successful psychopaths”)

What is the underarousal hypothesis?

cortical arousal is too low —> antisocial personality

Describe the Cortical immaturity hypothesis.

cerebral cortex is not fully developed —> antisocial personality disorder

What is the Fearlessness hypothesis?

Fail to respond to danger cues —> antisocial personality

Describe the Gray’s model.

Inhibition signals are outweighed by reward signals —> antisocial personality

What are the neurobiological contributions to antisocial personality disorder?

• Underarousal hypothesis

• Cortical immaturity hypothesis

• Fearlessness hypothesis

• Gray’s model

What are some of the psychological and social influences of antipersonality disorders?

In research studies, psychopaths are less likely to give up when goal becomes unattainable – may explain why they persist with behavior (e.g., crime) that is punished

Describe the arousal theory.

People with APD are chronically under-aroused and seek stimulation from the types of activities that would be too fearful or aversive for most

What is impaired fear conditioning?

Children who develop APD may not adequately learn to fear aversive consequences of negative actions (e.g., punishment for setting fires)

What are developmental influences of antisocial personality disorder?

• High-conflict childhood increases likelihood of APD in at-risk children

What are genetic influences of antisocial personality disorder?

• More likely to develop antisocial behavior if parents have a history of antisocial behavior or criminality

APD is the result of….

multiple interacting factors

Describe the mutual biological-environmental influence of antisocial personality disorder.

• Early antisocial behavior alienates peers who would otherwise serve as corrective role models

• Antisocial behavior and family stress mutually increase one another

Describe the treatment of antisocial personality disorder.

• Few seek treatment on their own

• Antisocial behavior is predictive of poor prognosis

• Emphasis is placed on prevention and rehabilitation

• Often incarceration is the only viable alternative

• May need to focus on practical (or selfish) consequences (e.g., if you assault someone you’ll go to prison)

Provide an overview of borderline personality disorder characteristics.

• Unstable moods and relationships

• Impulsivity, fear of abandonment, very poor self-image

• Suicidal and nonsuicidal self-injurious thoughts and behaviors

Is comorbitiy high for borderline personality disorder? If yes, with what disorders?

Comorbidity rates are high with other mental disorders, particularly mood disorders, substance use disorders, and eating disorders

What are the risks of borderline personality disorder?

• Strong genetic component

• High emotional reactivity may be inherited

• May have impaired functioning of limbic system

• Early trauma/abuse increases risk

What is the “triple vulnerability” model for borderline personality disorder?

• Generalized biological vulnerability

• Generalized psychological vulnerability

• Specific psychological vulnerability

What are the treatment options for borderline personality disorder?

• Antidepressant medications provide some short-term relief

• Dialectical behavior therapy

Describe dialectical behavior therapy.

most promising treatment for BPD

• Focus on dual reality of acceptance of difficulties and need for change

• Focus on interpersonal effectiveness

• Focus on distress tolerance to decrease reckless/self-harming

behavior

What are the components of dialectical behavior therapy?

• Individual therapy

− Keep the person alive

− Help them have a life worth living

• Phone Consults

− Only to coach through coping strategies

• Group Therapy

− Mindfulness

− Emotion regulation

− Interpersonal effectiveness

− Distress tolerance

• Support group for therapists

− To prevent burnout

What are the causes of Histrionic personality disorder?

• Etiology unknown due to lack of research

What are the treatment options of Histrionic personality disorder?

• Focus on attention seeking and long-term negative consequences

• Targets may also include problematic interpersonal behaviors

• Little evidence that treatment is effective

Provide an overview of histrionic personality disorder.

• Overly dramatic and sensational

• May be sexually provocative

• Often impulsive and need to be the center of attention

• Thinking and emotions are perceived as shallow

• More commonly diagnosed in females

Provide an overview of narcissistic personality disorder.

• Exaggerated and unreasonable sense of self-importance

• Preoccupation with receiving attention

• Lack sensitivity and compassion for other people

• Highly sensitive to criticism; envious and arrogant

What are some of the causes of Nacissistic personality disorder?

Largely unknown

• Failure to learn empathy as a child

• Sociological view – product of the “me” generation (Baby Boomers)

Describe the treatment options of Narcissistic personality disorder.

• Focus on grandiosity, lack of empathy, unrealistic thinking

• Emphasize realistic goals and coping skills for dealing with criticism

• Little evidence that treatment is effective

What is being described below?

A pervasive pattern of disregard for and violation of the rights of others.

Antisocial personality disorder.

What is being described below?

A pervasive pattern of instability of interpersonal relationships, self-image, affects, and control over impulses.

Borderline personality disorder

What is being described below?

A pervasive pattern of excessive emotion and attention seeking.

Histrionic personality disorder

What is being described below?

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy.

Narcissistic personality disorder

What are the disorders in Cluster B?

• antisocial personality disorder

• Borderline personality disorder

• Histrionic personality disorder

• Narcissistic personality disorder

Provide an overview of Avoidant personality disorder.

• Extreme sensitivity to the opinions of others

• Highly avoidant of most interpersonal relationships

• Interpersonally anxious and fearful of rejection

• Low self-esteem

Describe causes of avoidant personality disorder.

• May be linked to schizophrenia; occurs more often in relatives of people

with schizophrenia

• Experiences of early rejection

• Childhood experiences of neglect, isolation, rejection, and conflict with

others

Describe treatment of avoidant personality disorder.

• Similar to treatment for social phobia

• Focus on social skills, entering anxiety-provoking situations

• Good relationship with therapist is important

Provide an overview of dependent personality disorder.

• Reliance on others to make major and minor life decisions

• Unreasonable fear of abandonment

• Clingy and submissive in interpersonal relationships

What are some of the causes of dependent personality disorder?

• Not well understood but may be linked to failure to learn independence

Describe treatment of dependent personality disorder.

• Therapy typically progresses gradually due to lack of independence

Describe Obsessive-compulsive personality disorder.

• Excessive and rigid fixation on doing things the right way

• Highly perfectionistic, orderly, and emotionally shallow

• Unwilling to delegate tasks because others will do them wrong

• Difficulty with spontaneity

• Often have interpersonal problems

• Obsessions and compulsions are rare

Describe the causes of Obsessive-compulsive personality disorder.

Not well known

• Moderate genetic contribution

What is being described below?

A pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation.

Dependent personality disorder.

What is being described below?

A pervasive pattern of preoccupation with Obsessive-compulsive personality disorder orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.

Obsessive-compulsive personality disorde

Describe treatment of obsessive-compulsive personality disorder.

• Treatment targets include cognitive reappraisal techniques to reframe

compulsive thoughts

• Target rumination, procrastination, and feelings of inadequacy

What is being described below?

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

Avoidant personality disorder

Unlike other disorders in the DSM, personality disorders have which characteristic?
a. They respond well to all types of psychotherapy.
b. They are usually self-limiting and brief.
c. They arise in adolescence and abate by old age.
d. They may not cause subjective distress to the person with the disorder.

D. They may not cause subjective distress to the person with the disorder.

How is the temporal course of personality disorders best described?
a. They begin in childhood and persist throughout life.
b. They begin in adulthood and persist throughout life.
c. They begin in adolescence but usually remit in adulthood.
d. They begin in childhood but usually remit in adolescence.

a. They begin in childhood and persist throughout life.

Clients with personality disorders tend to bring out emotions in therapists that may interfere with treatment. What kind of emotions are these?
a. Positive
b. Pitying
c. Negative
d. Empathetic

C. Negative

Most diagnoses of mental disorders are either-or diagnoses. An individual either has a symptom of the disorder or does not, and the individual ultimately has the disorder or does not. An alternate model for personality disorders, which relies on the degree of dysfunction has been proposed. What is this type of model called?
a. Functional model
b. Categorical model
c. Dimensional model
d. Pathological model

c. Dimensional model

Porfirio has been mistrustful and suspicious of others since childhood and this tendency has caused significant problems at work and at home. If Porfirio were to see a therapist, which personality disorder would be most likely to be diagnosed?
a. Schizoid
b. Schizotypal
c. Narcissistic
d. Paranoid

D. Paranoid

Which personality disorder is believed by some to be on a continuum with schizophrenia and is included both as a personality disorder and a schizophrenia spectrum disorder?
a. Borderline
b. Schizotypal
c. Paranoid
d. Schizoid

B. Schizotypal

Treatment of which personality disorder often includes social skills training, including role-playing?
a. Histrionic
b. Schizoid
c. Borderline
d. Schizotypal

B. Schizoid

Comparison of the criteria for psychopathy and antisocial personality disorder indicates which of the following?
a. Criteria for psychopathy are based on self-report, while those for antisocial personality disorder are based on reports from others.
b. Criteria for psychopathy focus on personality traits, while those for antisocial personality disorder include both personality traits and behavior.
c. Criteria for psychopathy focus on interpersonal problems, while those for antisocial personality disorder focus on distress of the individual with the disorder.
d. Criteria for psychopathy are based on an understanding of neurobiology, while those for antisocial personality are rooted in a behavioral approach.

B. Criteria for psychopathy focus on personality traits, while those for antisocial personality disorder include both personality traits and behavior.

What tends to distinguish people who are diagnosed with psychopathy who do get into trouble with the law from those who do not?
a. Comorbid conditions
b. Intelligence quotient
c. Parental involvement
d. Genetic factors

b. Intelligence quotient

Joseph, aged 11, is widely regarded as a difficult problem. He seems devoid of empathy and is cruel to his peers and animals, and he has been caught drinking alcohol several times. He is openly defiant of authority and has engaged in theft, assault, and, recently, set a fire at the home of a neighbor who had reported Joseph to the police for vandalism. The juvenile court has ordered that Joseph undergo a psychological evaluation. Given his history, which disorder might Joseph be diagnosed with?
a. Antisocial personality disorder
b. Conduct disorder
c. Disruptive-mood dysregulation disorder
d. Intermittent explosive disorder

B. Conduct disorder

Of Gray's three brain systems believed to influence learning and emotional behavior, which appear to be involved in psychopathy?
a. The behavioral inhibition system (BIS), the reward system, and the fight/flight system
b. The behavioral inhibition system and the fight/flight system
c. The behavioral inhibition system and the reward system
d. The reward system and the fight/flight system

C. The behavioral inhibition system and the reward system

Amanda has a diagnosis of a personality disorder and has a long history of instability in emotion, interpersonal relationships, self-concept, and behavior. She is, in fact, regarded as "stably unstable." What is the most likely diagnosis for Amanda?
a. Narcissistic
b. Avoidant
c. Histrionic
d. Borderline

D. Boarderline

Treatment for which disorder is often complicated by problems with drug use, noncompliance with treatment, and suicide attempts?
a. Avoidant
b. Borderline
c. Schizoid

B. Borderline

In dialectical behavioral therapy, which type of behaviors are prioritized?
a. Behaviors that may interfere with therapy
b. Behaviors that may result in harm
c. Behaviors that interfere with quality of life
d. All problem behaviors are given equal priority

b. Behaviors that may result in harm

Which personality disorder is associated overly dramatic behavior, like effusively hugging and kissing someone who is a passing acquaintance, not a close friend?
a. Histrionic
b. Borderline
c. Narcissistic
d. Avoidant

a. Histrionic

Which personality disorder is associated with extreme self-centeredness and a sense of grandiosity?
a. Histrionic
b. Borderline
c. Avoidant
d. Narcissistic

D. Narcissistic